Healthcare and economic burden of adverse events among patients with chronic myelogenous leukemia treated with BCR-ABL1 tyrosine kinase inhibitors

Objectives: BCR-ABL1 tyrosine kinase inhibitors (TKIs) are established treatments for chronic myelogenous leukemia (CML); however, they are associated with infrequent, but clinically serious adverse events (AEs). The objective of this analysis was to assess healthcare resource utilization and costs associated with AEs, previously identified using the FDA Adverse Event Reporting System (FAERS) in another study, among TKI-treated patients.

Methods: Adult patients with ≥1 inpatient or ≥2 outpatient ICD-9-CM diagnosis codes for CML and ≥1 claim for a TKI treatment between January 1, 2006 and September 30, 2012 were identified from the Commercial and Medicare MarketScan databases. The first claim for a TKI was designated as the index event. Patients were required to have no TKI treatment during a 12-month baseline period. Healthcare resource utilization and costs associated with select AEs having the strongest association with TKI treatment (femoral arterial stenosis [FAS], peripheral arterial occlusive disease [PAOD], intermittent claudication, coronary artery stenosis [CAS], pericardial effusion, pleural effusion, malignant pleural effusion, conjunctival hemorrhage) were evaluated during a 12-month follow-up period.

Results: The study sample included 2,005 CML patients receiving TKI therapy (mean age?=?56 years; 56% male). Among all evaluated AEs, the highest mean inpatient healthcare costs were observed for FAS ($16,800 per patient) and PAOD ($14,263 per patient), which had total mean medical costs (inpatient?+?outpatient) of $17,015 and $15,154 per patient, respectively. Mean outpatient healthcare costs were highest for CAS ($1,861 per patient), followed by intermittent claudication ($947 per patient), PAOD ($891 per patient), and pleural effusion ($890 per patient). Total mean medical costs for fluid retention-related AEs, including pericardial effusion and pleural effusion, were $2,797 and $1,908 per patient, respectively.

Conclusions: The healthcare costs of AEs identified in the FAERS as having the strongest association with TKI treatment are substantial. Vascular stenosis-related AEs, including FAS and PAOD, have the highest cost burden.     

Economic modeling to evaluate the impact of chronic myeloid leukemia therapy management on the oncology care model in the US

Abstract

Objective: To develop an economic model to evaluate changes in healthcare costs driven by restricting usage of branded tyrosine kinase inhibitors (TKIs) through substitution with generic imatinib among chronic myeloid leukemia (CML) patients in a typical Oncology Care Model (OCM) practice, and examine the impact on Performance-Based Payment (PBP) eligibility.

Methods: An Excel-based economic model of an OCM practice with 1,000 cancer patients during a 6-month episode of care was developed. Cancer types and proportions of patients treated in the practice were estimated from an OCM report. All-cause healthcare costs were obtained from published literature. It was assumed that if a practice restricts usage of branded TKIs for newly-diagnosed CML patients, 80% of the market share of branded imatinib and 50% of the market shares of 2^nd-gen TKIs would shift to generic imatinib. Among established TKI-treated patients, it was assumed that 80% of the market share of branded imatinib and no patients treated with 2^nd-gen TKIs would shift to the generic.

Results: Four CML patients were estimated for a 1,000-cancer patient OCM practice with a total baseline healthcare cost of $51,345,812 during a 6-month episode. If the practice restricts usage of branded TKIs, the shift from 2^nd-gen TKIs to generic imatinib would reduce costs by $12,970, while shifting from branded to generic imatinib lowers costs by $25,250 during a 6-month episode. Minimum reductions of $3,013,832 in a one-sided risk model and $2,372,010 in a two-sided risk model are required for PBP eligibility; the shift from 2^nd-gen TKIs to generic imatinib would account for 0.4% and 0.5% of the savings required for a PBP, respectively.

Conclusions: This analysis indicates that the potential cost reduction associated with restricting branded TKI usage among CML patients in an OCM setting will represent only a small proportion of the cost reduction needed for PBP eligibility.     

Balancing the dual mandate of conservation and visitor use at a Canadian world heritage site in an era of rapid climate change

Abstract

National parks in Canada operate under the dual mandate of conservation and visitor use, which involves balancing ecological integrity and nature-based tourism activities. Climate-induced environmental change may increase the existing tension between conservation and visitor use as major tourism resources located in protected areas (PAs) are projected to undergo large-scale changes. This study draws upon the behavioural approach, scenario planning, and landscape visualizations to examine the relationship between climate change impacts, visitor perceptions, and visitor experience management at the Athabasca Glacier in Jasper National Park, Canada. Four tourism development scenarios defined by two management drivers (ecological integrity and visitor demand) with corresponding storylines and visualizations were developed for 2050. The visualized scenarios were presented to visitors (n?=?304) in a survey to understand potential implications on visitor satisfaction. The results suggest that park managers need to find a balance between ecological integrity and visitor use in a way that ensures commercialized tourism development is limited, educational material is prioritized, and ecological integrity is maintained. While understanding the behaviour of future tourists is complex, it is a critical component of climate change adaptation planning and decision-making processes that needs to be prioritized by policymakers and PAs managers.     

Emotion,affect, and risk communication with older adults: challenges and opportunities

Recent research suggests that emotion, affect, and cognition play important roles in risk perception and that their roles in judgment and decision‐making processes may change over the lifespan. This paper discusses how emotion and affect might help or hinder risk communication with older adults. Currently, there are few guidelines for developing effective risk messages for the world's aging population, despite the array of complex risk decisions that come with increasing age and the importance of maintaining good decision making in later life. Age‐related declines in cognitive abilities such as memory and processing speed, increased reliance on automatic processes, and adaptive motivational shifts toward focusing more on affective (especially positive) information mean that older and younger adults may respond differently to risk messages. Implications for specific risk information formats (probabilities, frequencies, visual displays, and narratives) are discussed and directions for future research are highlighted.     

An Investigation of the Relationship between Use of International Accounting Standards and Source of Company Finance in Germany

This study examines the relationship between use of international accounting standards and companies’ source of finance. We investigate the proposition contained in Nobes’ (1998) model that postulates outsider companies (those with a higher level of public finance) in weak equity–outsider markets (capital markets where public equity finance is not the dominant source of finance) are more likely to change their type of accounting system from one focused on information for creditors and tax authorities to one that meets the needs of external financiers. We found strong support for Nobes’ model. Using 408 German listed companies at 1999, we observed that companies with more outsider finance (the proportion of shares held by outsiders and the presence of public debt) were more likely to use international standards (U.S. GAAP or IAS). The results indicate the importance of controlling for source of finance at the company rather than country level in cross‐country studies investigating the benefits of adoption of international standards.     

Embodiment--the Aesthetics of Incorporation

This paper examines contemporary developments in 3D immersive data and experience as a method of information and organizational design. With particular attention to its historic forbearers, contemporary theorists and current graphical tools, this paper anticipates specific concerns and possible technological developments in virtual organizational design. As artists, new developments in technology present opportunities to restructure organizational life both virtually and materially. Computer animation industry growth leaped 30% in fiscal year 1998 topping $20 billion in annual revenues. As the animation and 3D immersive industry expands platforms and applications shift. The most successful of these adapt while others dissipate. Nonetheless current management and organizational structures are challenged to engage a world that increasingly visualizes and communicates in 3D.     

React to the future: political visualization,emotional reactions and political behavior

Abstract

This study explores the mediating role political visualization – the process of imagining future political scenarios – plays in determining how political advertising affects voting behaviour. Specifically, we theorize that when partisans are exposed to political ads that are narrative (compared to non-narrative) in nature, they will engage in more political visualization. Partisans will then experience emotional reactions to these imagined futures – specifically, enthusiasm for the in-group candidate and anger towards the out-group candidate. These emotional reactions, in turn, will make a partisan more likely to vote for the in-group candidate and less likely to vote for the out-group candidate. We test this model by employing an experimental design where American partisans were presented a political ad (in the form of an email) that is either narrative or non-narrative. Results provide support for most of our expectations and suggest that visualization may play an important role in determining the influence of a political ad.     

Toward a more complete understanding of offshoring: bringing employees into the conversation

The rapid increase in the practice of offshoring over the past decade has generated considerable debate about the consequences of this trend for the economy and for labor. A burgeoning literature examines a variety of issues related to offshoring; however, the majority have focused primarily on macro-level issues such as why organizations decide to offshore or why some ventures succeed and some fail. Very little research has examined the impact of exporting work on the attitudes and behaviors of employees in the destination country who are performing the work. We seek to address this gap in the literature by identifying the distinguishing characteristics of the offshore work environment and developing a theoretical framework for understanding destination workers' experiences and responses in this environment. Drawing on social identity theory and related research, we develop a multilevel model for explaining the antecedents and consequences of the identity conflicts that often arise among destination workers employed in voice-based service work.     

ECONOMIC POLICY UNCERTAINTY AND BOARD MONITORING: EVIDENCE FROM CEO TURNOVERS

We examine whether economic policy uncertainty (EPU) affects a board's chief executive officer (CEO) replacement decision. We find that high EPU reduces the likelihood of forced CEO turnover. Our results support the idea that performance assessment may be more difficult when uncertainty is high. We provide evidence that succession planning may be important to firms in reducing the effects of EPU, as firms with an identifiable heir apparent are not influenced by high EPU. Likewise, voluntary CEO turnovers are not affected by EPU. Overall, our results provide evidence that boards make personnel decisions in response to external macroeconomic pressures.     

Are Earnings Forecasts Informed by Proxy Statement Compensation Disclosures?

We investigate the extent to which market participants use compensation payouts released in the DEF 14A proxy statement (DEF14A) to assess future firm performance by examining sell-side analysts' earnings forecasts. Consistent with prior work, we confirm that CEO compensation unexplained by current observable economic factors is positively associated with future firm performance. We find that both the likelihood that analysts revise their forecasts following release of the DEF14A and the magnitude and direction of analysts' forecast revisions are positively associated with unexplained CEO compensation. These associations are stronger after the SEC required additional compensation-related disclosures in late 2006 but lower if the firm has weak corporate governance or more precise other information. Analysts' reactions are not complete, however. Analysts' forecast errors measured months after the DEF14A release are associated with past unexplained compensation, especially in the pre-2006 period and for analysts who do not revise at the DEF14A release. Taken together, our results suggest that compensation payouts released in the DEF14A contain useful forward-looking information that is recognized by at least some sophisticated market participants and that the increased disclosure regulations assisted market participants in incorporating this information.